@layout("/common/_form.html",{js:["/assets/manager/flowBill/flowBill_edit.js"]}){

<form class="layui-form" id="flowBillForm" lay-filter="flowBillForm">
    <div class="layui-fluid" style="padding-bottom: 75px;">
        <div class="layui-card">
            <div class="layui-card-header">基本信息</div>
            <div class="layui-card-body">
                <div class="layui-form-item layui-row">
                    <input name="billId" type="hidden"/>
                    <input name="orderId" id="orderId" type="hidden"/>
                    <input name="storeId" id="storeId" type="hidden"/>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">订单编号<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="orderCode" name="orderCode" placeholder="请输入订单编号" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">状态</label>
                        <div class="layui-input-block">
                            <select id="status" name="status" lay-filter="status">
                                <option value="0">待处理</option>
                                <option value="1">处理中</option>
                                <option value="2">已开票</option>
                                <option value="3">此单作废</option>
                            </select>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">抬头类型<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <select id="titleType" name="titleType" lay-filter="titleType">
                                <option value="0">企业/单位</option>
                                <option value="1">个人/非企业单位</option>
                            </select>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">发票抬头<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="title" name="title" placeholder="请输入发票抬头" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">纳税号<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="idCode" name="idCode" placeholder="请输入输入纳税号" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">备注</label>
                        <div class="layui-input-block">
                            <input id="note" name="note" placeholder="比如：搬家服务" type="text" class="layui-input"/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">开票金额<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="moneys" name="moneys" placeholder="请输入开票金额" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">开票类型<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <select id="billType" name="billType" lay-filter="titleType">
                                <option value="0">纸质发票</option>
                                <option value="1">电子发票</option>
                            </select>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">联系人</label>
                        <div class="layui-input-block">
                            <input id="contact" name="contact" placeholder="请输入联系人" type="text" class="layui-input"/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">联系电话</label>
                        <div class="layui-input-block">
                            <input id="phone" name="phone" placeholder="请输入" type="text" class="layui-input"/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">联系地址</label>
                        <div class="layui-input-block">
                            <input id="address" name="address" placeholder="请输入" type="text" class="layui-input"/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">邮箱</label>
                        <div class="layui-input-block">
                            <input id="email" name="email" placeholder="请输入邮箱" type="text" class="layui-input"/>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
    <div class="form-group-bottom text-center">
        <button class="layui-btn" lay-filter="btnSubmit" lay-submit>&emsp;提交&emsp;</button>
        <button type="reset" class="layui-btn layui-btn-primary" ew-event="closeDialog">&emsp;取消&emsp;</button>
    </div>

</form>

@}